CNM Purple Thin Book Study Questions 2013

Question 1

Cancer screening recommendations from American Cancer Society on mammograms

Answer 1

Women age 40 or older should have annual mammograms continuing for as long as the woman is in good health

Question 2

Cancer screening recommendations from American Cancer Society on Paps

Answer 2

Age 21-29, q 3 yrs if wnl
Age 30-39 q 5 yrs if wnl (with HPV testing)
Age 40+ …

Question 3

Cancer screening recommendations from American Cancer Society on fecal occult blood testing FOBT

Answer 3

shoudl be conducted annually starting at age 50

Question 4

Cancer screening recommendations from American Cancer Society on sigmoidoscopy/colonoscopy

Answer 4

Starting at age 50
sigmoidoscopy q 5 yrs -OR-
colonoscopy q 10 yrs -OR-
double-contrast barium enema q 5 yrs -OR-
CT colonography q 5 yrs

Question 5

CDC recommendations for 65 yr old

Answer 5

Influenza should be given annually.
All immunocompetent individuals 65 or older should be immunized once with pneumococcal vaccine (one-time revax if vax 5 or more years previously and less than 65 at time).
Adults should receive Td booster vax q 10 yrs.
Herpes zoster vax rec for individuals age 60+.

Question 6

Fat intake recommendations from AHA

Answer 6

Total fat 25-35% of total daily caloric intake

Saturated fats <1% tdci

Question 7

Where are trans fats found?

Answer 7

in products that contain partially hydrogenated fat

as well as in meat and whole-fat dairy products

Question 8

One strategy for replacing saturated fats with unsaturated fats

Answer 8

Replace meats with veg alternatives (eg beans) or fish

Will reduce cholesterol content

Question 9

Sat fat v cholesterol content in peanut butter

Answer 9

low in cholesterol

high in saturate fat

Question 10

Five stages of Thranstheoretical Model for Change

Answer 10

precontemplation
contemplation
action
maintenance/relapse prevention
relapse

Question 11

Bupropion

Answer 11

antidepressant which is helpful in smoking cessation (likely due to effect on neuroal uptake of dopamine, prolonging action of nt)
Weight gain NOT a s/e
Start bupropion 1-2 wks before quit date so blood levels of med will be satbilized.
Bupropion is C/I in sz disorder and eating disorders

Question 12

Criteria for dx of IBS

Answer 12

Continuous or recurrent sx, for at least 3 months of:
abdominal pain or discomfort relieved with defecation -OR- associated with a change in frequency or consistency of stool
Must also have irregular pattern of defecation at least 25% of time with =3/+ of:
altered stool frequency/form/passage, passage of mucus and bloating, or feeling of abdominal distention
Typical IBS does NOT waken individual nor does it result in significant weight loss
Physical activity generally does not cause an increase in severity of sx.
Regular physical exercise may be beneficial

Question 13

Appropriate treatment for both diarrhea and constipation IBS

Answer 13

increasing dietary fiber, which will result in a bulkier stool.
Bulk forming agents such as psyllium husk fiber and methylcellulose can also be used.

Question 14

What laxative types are ok occasionally for pt with constipation IBS?

Answer 14

stool softeners

osmotic laxatives

Question 15

What type of laxatives should be avoided as much as possible in someone with constipation-predominant IBS?

Answer 15

Avoid stimulant laxatives

Question 16

26 yr old with abrupt-onset diarrhea that began 24 hours ago; has had approx 6 loose stools without noticeable blood; mild abdominal cramps, neg nausea, neg fever.

Answer 16

Acute diarrhea. Usually self-limiting.
Maintain oral hydration rich in electrolytes.
Restart foods slowly as toleated with clear liquids and then carbs.
Resume protein and fats last.
Stool culture may be indicated if sx persist and/or fever/bloody stools.

Question 17

32 yr old. 3-month hx intermittent burning retrosternal pain that radiates to her back.
Sx noted 30-60 minutes after meal; relieved quickly with antacids. PE and VS wnl.

Answer 17

GERD gastroesophageal reflux disease
sx include intermittent nature,
association of relief with antacids

Question 18

cholecystitis

Answer 18

Usually colicky, constant, in RUQ

Deep inspiration usually causes severe pain and splinting of repirations (Murphy’s sign)

Question 19

If gastric irritation with ingestion of iron supplement on empty stomach (recommended):

Answer 19

Ingest with food to reduce irritation.
Try another preparation.
Increase slowly from small dose.

Question 20

Antacids for gastric irritation while taking iron supplement:

Answer 20

inhibit absorption

Question 21

to increase iron absorption

Answer 21

take iron supplement with vit C

Question 22

test to determine iron stores

Answer 22

serum ferritin level (major storage protein)

Is located in serum [ ] directly r/t iron stores

Question 23

test of choice for distinguising bt carrier and affected state of sickle cell

Answer 23

Hgb electrophoresis

Question 24

test which is very effective at distinguishing types of hemoglobin in a blood sample

Answer 24

Hgb electrophoresis

Question 25

Is Sickledex a screening or diagnostic test

Answer 25

screening test for SCA/SCT; must be confirmed with Hgb electrophoresis

Question 26

When to migraine HA usually begin

Answer 26

adolescence or early adulthood, though they can occur in young children

Question 27

where are migraines usually located?

Answer 27

unilaterally

Question 28

sx of migraine HA

Answer 28

throbbing, can last up to 72 hours often accompanied by nausea and photophobia

Question 29

what is indicated for preventive therapy of migraine HA that come 2 or more x/mo?

Answer 29

beta-adrenergic blocking agents (propranolol)

Question 30

meds used for abortive or analgesic therapy of acute migraines

Answer 30

codeine-containing products ergotamine preparations sumatriptian

Question 31

carpal tunnel sx

Answer 31

dull aching pain across wrist and forearm with paresthesia, weakness or clumsiness of hand. Nocturnal pain and radiation of pain up to proximal forearm. PE may also identify muscle atrophy and dry skin of affected hand

Question 32

Tinel's sign

Answer 32

elicited by tapping over median nerve at th e palmar surface of wrist

Question 33

+ Tinel's sign

Answer 33

client has tingling or prickling sensation along first three digits wrist pain weak grip Seen in carpal tunnel syndrome

Question 34

+Phalen's sign

Answer 34

client experiences numbness and paresthesia in fingers innervated by median nerve after maintaining palmar flexion for 1 minute Seen in carpal tunnel syndrom

Question 35

Most common cause of sciatica

Answer 35

herniated intravertebral disk

Question 36

sx of herniated intravertebral disc

Answer 36

low back pain | burning that radiates along lateral thigh, leg and foot

Question 37

PE findings of herniated disc

Answer 37

pain below knee with elevation of affected leg with pt in sitting or supine (+straight leg raise). Pain could also be in buttocks and posterior thigh

Question 38

exercises helpful in preventing recurrence of lumbosacral back strain

Answer 38

abdominal strengthening exercise

Question 39

relief measures for lumbosacral back strain

Answer 39

heat, cold packs, or both. Limit bedrest to 2-3 days. Back stretching are of LITTLE VALUE

Question 40

osteoarthritis

Answer 40

degenerative dz of cartilage of joints. | most common form of chronic arthritis (up to 25% adult pop)

Question 41

common presenting hx of osteoarthritis

Answer 41

asymmetrical joint pain and stiffness that improves through day

Question 42

joints typically involved in osteoarthritis

Answer 42

distal and proximal interphalangeal joints, hips, knees and cervical/lumbar spine

Question 43

PE for osteroarthritis

Answer 43

crepitus; limited ROM of joints Joints feel cool with bony enlargement Constitutional signs like fatigue and malaise NOT CHARACTERISTIC

Question 44

Fibromyalgia

Answer 44

unexplained widespread pain or aching, persistent fatigue, generalized morning stiffness, non-refreshing sleep, multiple tender points bilaterally in UE/LE. NOT CHARACTERISTIC: changes in ROM, swelling in joints, abnormal neurologic findings

Question 45

Contact Dermatitis

Answer 45

pruritus or burning at site of contact of an irritant or allergen. Lesions vary depending on stage of response. In acute stage, erythema and oozing vesicles common.

Question 46

Fungal infection

Answer 46

typically affects scalp, trunk, limbs, face, groin or feet. | Characterized by erythematous scaling plaques

Question 47

Cellulitis

Answer 47

characterize by diffuse, sharply defined erythema. | Red streaks run from cellulitis to regional lymph nodes

Question 48

Scabies

Answer 48

characterized by minute vesicles and linear runs or burrows often found in digital webs, palms, writs, gluteal folds, buttocks, and toes

Question 49

Pt presents with recent onset of irregular patches of erythema and oozing vesicles on hands, itching and burning of affected area. What is it?

Answer 49

uncomplicated contact dermatitis

Question 50

tx for uncomplicated contact dermatitis

Answer 50

topical corticosteroid agents are generally effective in tx of mild, umcomplicated contact dermatitis. (more severe epidoses may need systemic corticosteroid therapy)

Question 51

Lyme dz PE

Answer 51

erythema migrans is annular and erythmatous with central pallor at site of tick bite. Lesion starts about 5cm and quickly grows to ~20 cm. Typically appears within 1 wk-1 month after tick bite. Nonpruritic

Question 52

s/s of lyme dz

Answer 52

constitutional sx such as fatigue, myalgias, arthralgia, HA and fever during localized phase that extend to sx of involvement of other organ systems if not tx early

Question 53

squamous cell carcinoma

Answer 53

ulcerated nodule with translucent surface and firm raised borders on the face Second most common skin cancer. Squamous cells compose most of skin's upper layers (epidermis). SCCs often look like scaly red patches, open sores, elevated growths with central depression or warts; may crust or bleed. SCC mainly caused by cumulative UV exposure. Lesion starts as a firm nodule or papule with thick scale that becomes eroded, crusted and ulcerated with raised pearly borders.

Question 54

basal cell carcinoma

Answer 54

usually appears on head, neck or hands as a small nodule that left untreated begins to bleed and crust over.

Question 55

Characteristics of malignant melanoma

Answer 55

``` A -asymmetry B-border ireegularity or notching C-color variation D - diamater >6mm Seen in all ages ```

Question 56

temporal arteritis

Answer 56

sharp, throbbing or aching pain localized to the temporal area. Other symptoms may include scalp tenderness, jaw pain with chewing, anorexia, weight loss, fatigue. Individual my have known hx of polymyalgia rheumatica. Unilateral blindness may occur if untreated. Age of onset usually older than age 50. Erythrocyte sedimentation rate will be >50 mm/hr.

Question 57

PE findings of temporal arteritis

Answer 57

fever, tenderness over a nodular temporal artery, decreased pulsation of the artery, diminished or absent pulses in upper extremities.

Question 58

sx of viral conjunctivitis

Answer 58

gradual onset of unilateral (may become bilat) scratchy sensation in the eye. No eye pain, vision changes or photophobia.

Question 59

PE of viral conjunctivitis

Answer 59

peripheral injection and a watery discharge.

Question 60

Allergic conjumctivitis

Answer 60

bilateral, both eyes are itchy. | Peripheral injection and mucoid discharge.

Question 61

Corneal abrasion

Answer 61

typically pain and photophobia

Question 62

subconjunctival hemorrhage

Answer 62

painless, no discharge | There is a splash of blood in conjunctiva and sclera.

Question 63

Substance dependence definition

Answer 63

maladaptive pattern of substance use, in the presence of at least 3 of 7 elements, occurring at any time in the same 12-month period. One element is a persistent desire to use the substance and/or unsuccessful efforts to cut down use. May experience tolerance (need more amt over time to achieve same effect) or withdrawal (substance-specific syndrome when substance stopped/decreased)

Question 64

substance abuse

Answer 64

Fail to fulfill major role obligations Use substances in situations that are physically hazardous Experience substance-related legal problems Continue to use substances despite having persistent or recurrent social or interpersonal problems caused or worsened by the effects of the substance

Question 65

acanthosis nigricans

Answer 65

velvety hyperpigmented patch found on back of neck, elbows, knuckles, knees, groin and axillary areas in obese women with mod-severe insulin resistance. Can also be seen in older adults with malignancies of GI tract and other adenocarcinomas

Question 66

Interstitial cystitis

Answer 66

aka painful bladder syndrome: pelvic pain, pressure or discomfort, typically associated with persistent urge to void or urinary freqency, in the absence of infection or other pathology. Nocturia common. Incontinence uncommon. Dyspareunia frequently seen in women with IC.

Question 67

s/s of anorexia nervosa

Answer 67

Depression is comon. Intense fear of loss of control. Amenorrhea is a dx criteria.

Question 68

s/s of bulimia nervosa

Answer 68

Depression in about 50%. Alcohol/drug abuse and lack of control May lead to menstrual irregularities but usually not amenorrhea

Question 69

Dx criteria for Major Depressive Episode

Answer 69

Five of the following during the same 2-wk period, represent a change from previous functioning, and include 1 of first 2. 1. depressed mood most of day by self-report or by others 2. loss of interest in most activities, most of day, nearly every day 3. significant weight change without trying, or daily change in appetite 4. insomnia/hypersomnia ~daily 5. psychomotor agitation or retardation per report of others 6. fatigue or loss of energy 7. feelings of worthlessness or excessive guilt 8. diminished ability to think or [ ], or indecisiveness 9. recurrent thoughts of death, suicidal ideation with or without plan

Question 70

First line tx for major depression

Answer 70

SSRIs and heterocyclic antidepressants

Question 71

SSRIs

Answer 71

eg, paroxetine | usually have an ENERGIZING effect and may lead to insomnia if taken at night, or even if taken during day

Question 72

Heterocyclic antidepressant

Answer 72

eg, Trazadone | sedative effect; most benefical to take it at night

Question 73

ADA recommendations to reduce risk of CVD in people with DM

Answer 73

HbA1c < 7% of total

Question 74

Weber test

Answer 74

tuning fork on top of head, equally between ears Defective ear hears it loudest - signifies conductive hearing loss because room noise will not be heard as well; detection of vibration in the impaired ear improves

Question 75

causes of conductive hearing loss

Answer 75

cerumen impaction, foreign bocy in ear, otitis media, perforated eardrum

Question 76

Cranial Nerve V Trigeminal

Answer 76

has both motor and sensory functions. Motor fxn tested by palpating temporal and masseter muscles while having pt clench teeth. Sensory fxn tested by evaluating pain and light touch sensation along the forehead, cheeks and jaw.

Question 77

inflammation of the pericardial sac with pericarditis produces what sound?

Answer 77

friction rub: a high-pitched scratchy sound with 2-3 short components associated with cardiac movement

Question 78

sx of pulmonary embolism

Answer 78

sudden onset of SOB, localized pleuritic (sharp with breathing) chest pain, apprehension, bloody sputum production, diaphoresis, fever, hx of conditions causing risk for embolism. Prolonged immobilization as may occur with long periods of air travel poses a risk

Question 79

PE finidings for pulmonary embolism

Answer 79

restlessness, fever, tachycardia, tachypnea, diminished breath sounds, crackles, wheezing, and pleural friction rub

Question 80

s/s of mitral valve prolapse

Answer 80

sharp, nonexertional chest pain of short duration. May be accompanied by palpitations and diaphoresis; anxiety and/or panic attacks. Often asymptomatic.

Question 81

Diagnostic hallmark of mitral valve prolapse

Answer 81

midsystolic click, a late systolic murmur, and an abnormally thickened, redundant mitral valve seen on echocardiogram

Question 82

Primary hypothyroidism

Answer 82

elevated TSH, suppressed FT4 | periobital edema, among other things

Question 83

female pubescent growth

Answer 83

beginning of accelerated growth is usually first sign of female puberty, but breast budding is first recognized pubertal change, followed by appearance of pubic and axillary hair. Peak growth occurs about 1 yr before menarchei

Question 84

viral pharyngitis s/s

Answer 84

malaise, fever, HA, cough, congestion and fatigue along with sore throat. PE include pharyngeal erythema, no/small amt exudate, neg lymphadenopathy

Question 85

bacterial pharyngitis

Answer 85

sudden onset of severe sore throat and fever. Usually no cough, no congestion. PE includes fever of 101.5 or higher, pharyngeal erythema and exudate, and anterior cervical lymphadenopathy

Question 86

Objective information is obtained during

Answer 86

PE or lab or dx test

Question 87

Subjective information includes

Answer 87

all aspects of the health hx from chief complaint through review of systems

Question 88

Problem list is ob/sub jective?

Answer 88

may be combination of both

Question 89

s/s of hyperthyroidism

Answer 89

nervousness, increased perspiration, weight loss despite an increased appetite, frequent bowel movements. exam findings include incr patellar reflexes, HR high side of normal, moderately enlarged, soft, nontender thyroid gland

Question 90

Grave's dz

Answer 90

comprises 70% of hyperthyroid cases and is seen most commonly in women 20-40 yr old.

Question 91

Subacute thyroiditis

Answer 91

a postviral illness that may cause transient hyperthyroidism. Thyroid is usually tender.

Question 92

Lipid screening

Answer 92

recommended q 5 yrs for all adults over 20 yr. If screening is nonfasting total cholesterol and HDL, a follow-up fasting lipid profile should be done in the following situations: total cholesterol 200 or more HDL less than 40 test results borderline in individual with 2 or more CVD risk factors

Question 93

CVD risk factors

Answer 93

``` female 55 yrs and older premature menopause male 45 yrs and older family hx of premature CVD smoking hypertension HDL <40 ```

Question 94

CVD risk equivalents

Answer 94

``` diabetes stroke known cerebrovascular dz peripheral vascular dz abdominal aortic aneurysm ```

Question 95

Bacterial pneumonia

Answer 95

pleuritic chest pain, cough productive of yellow sputum, elevated temp, elevated respirations, HR high nl, somewhat dehydrated

Question 96

PE bacterial pneumonia

Answer 96

findings of consolidation assoc with pneumonia would include increased vocal fremitus, presence of bronchophony, dullness to percussion over affected lung areas

Question 97

American Cancer Society guidelines for colon cancer screening

Answer 97

start at age 50 single-specimen FOBT not rec option (5% sensitivity). six-sample home FOBT 24% sensitive. Vit C may cause false-negative results. Pos results on FOBT shoudl be followed up with colonoscopy

Question 98

CDC criteria for considering 5-10 mm induration a +tuberculin skin test

Answer 98

HIV infection, recent close contact with a person with active TB infection, fibrotic lesions or evidence of old, healed TB on chest radiograph, or immunosuppression

Question 99

ANA + in?

Answer 99

``` autoimmune dz such as RA SLE scleroderma Sjorgren's syndrome ```

Question 100

SLE management

Answer 100

Local and systemic corticosteroids are used in tx. Avoid strong sunlight and use sunscreen and protective clothing to avoid extensive exposure that can exacerbate lupus skin rash and active dz. Women with SLE who have unknown or +antiphospholipid antibodies should not use ESTROGEN-containing contraception. Progestin-only contraception, non-hormonal IUDs, and barrier methods may be acceptable. Autoimmune antibody testing is used in dx of SLE.

Question 101

HIV testing

Answer 101

both enzyme immunoassay (EIA) and rapid HIV are considered highly sensitive as initial screening tests for HIV. Must be confiremed by Western blot or immunofluorescense assay.

Question 102

Hepatitis B surface antibody (HBsAB)

Answer 102

appears approx 4-5 months after infection; is an indicator of immunity. Also detectable in individuals who have passive immunity secondary to hep B vaccination

Question 103

Chronic fatigue syndrome

Answer 103

For 6 months or more: fatigue that interferes with physical, mental, social and educational activities PLUS 4 of the following eight things: sore throat short-term memory or concentration impairment tender cervical or axillary lymph nodes headaches of a new type/pattern/severity unrefreshing sleep postexertional malaise lasting more than 24 hours multijoint pain without swelling or inflammation muscle pain

Question 104

Evidence-based tx for Chronic Fatigue Syndrome

Answer 104

A supervised, graded aerobic exercise program results in improvements in fatigue and physical functioning. Cognitive behavioral therapy is beneficial. There is insufficient evidence to support benefits of antidepressants, corticosteroids, or multivitamins.